AUICK Study Course on ICPD and Health Care 1998

THEME

Family Planning, Reproductive Health and Maternal and Child Health.

BACKGROUND

The Asian Urban Information Center of Kobe (AUICK), in collaboration with the United Nations Population Fund (UNFPA) and the City of Kobe, held the four-day Study Course on ICPD and Health Care in Singapore from October 21-24, 1998. The course was designed for administrative officials in Asian cities involved in health rarp and mpHirinp

In 1994, representatives from over 180 countries gathered in Cairo for the ICPD (International Conference on Population and Development) to discuss issues on population and sustainable development. At the conference, the concept of "Reproductive Health/Rights" was announced. This idea recognizes a woman's right to decide how many children they will have and when they will bear them. Protecting and nurturing this right will lead to the stabilization of the world population. All of the countries that participated in ICPD adopted the "Programme of Action" in order to safeguard reproductive health/rights.

AIM

The primary objective of the study course was to grasp to what degree the ideas decreed in the "Programme of Action" were reflected in the health care policies of each city. A secondary objective was to learn about Singapore's ideas, policies and past experiences in the field of health care.

Singapore was chosen as the site of the course because it was felt that having participants share their experiences in a region culturally and socially similar to their own would result in a more effective training course. In addition to introducing the past experience and present condition of Singapore, which realized development in a short period of time, the course curriculum also included time for discussion through which participants deepened mutual understanding.

PARTICIPANTS

[Course Leaders]

Dr. Toshio Kuroda
Member of AUICK International Advisory Committee (Professor, Nihon University), JAPAN

Dr. Goh Lee Gan
Associate Professor, Department of COFM, National University of Singapore, SINGAPORE

Dr. Lau Hong Choon
Deputy Director, Human Resource Development, MOH, SINGAPORE

Dr. Lim Lean Huat
Adjunct Senior Lecturer, Dept of COFM, National University of Singapore, SINGAPORE

Dr. Siaw Tung Yeng
Head, Woodlands Polyclinic, SINGAPORE

[Senior Officials from Selected Cities]

Dr. Salim Akhter Chowdhury
Assistant Health Officer, Chittagong City Corporation, BANGLADESH

Mr. Hou Qingchang
Deputy Director, Tianjin Municipal Research Institute for Family Planning,  CHINA

Dr. Muhlas Udin
Chief, Mother and Child Welfare, Surabaya Municipality,  INDONESIA

Dr. Rai Qamar-uz-Zaman
Health Officer South Zone, Faisalabad Municipal Corporation, Faisalabad, PAKISTAN

Dr. Pacita Encina Alcantara
City Health Officer II, Olongapo City, PHILIPPINES

Ms. Patsawadee Churbundit
Director, Public Health Division, Khon Kaen Municipality, THAILAND

Dr. Dao Thi Chut
Deputy Director, Maternal and Child Health Care and Family Planning Center, Health Department, Haiphong, VIETNAM

[Associate Participants]

Dr. Lam Kian Ming
Paramedical Unit, Ministry of Health, SINGAPORE

Dr. Angela Chow
Epidemiology and Disease Control Department, Ministry of Health, SINGAPORE

Dr. Yasuto Kawakami
Director, Public Health Department, Tarumi Ward Office, City of Kobe, JAPAN
 

PERIOD

Wednesday, 21 October to Saturday, 24 October 1998.

SCHEDULE/PROGRAM

REVIEW

Various projects conducted by Asian Urban Information Center of Kobe (AUICK) have been held in Kobe, Japan with the exception of research, consulting meetings and other specific objectives.

Fortunately, with generous support and assistance from the staff of the Ministry of Health of Singapore and other excellent professors in ingapore, "The Study Course on ICPD* and Health Care", the first study course we held outside of Japan, proved remarkably successful.

The study course aimed to discuss the current state of family planning, reproductive health and maternal and child health, major topics at the ICPD, in seven selected cities in Asia, namely, Chittagong angladesh), Tianjin (China), Surabaya (Indonesia), Faisalabad (Pakistan), longapo (Philippines), Khon Kaen (Thailand) and Haiphong (Vietnam). Of the seven participants, five are M.D.s and the other two are a municipal administrator responsible for public health administration and a senior researcher.

The Programme of Action approved by the ICPD at Cairo, 1994, are quite specific in dealing with country to country. How to realize recommendations approved by the ICPD is not an easy task for countries with divergent systems.

The participants must have had excellent opportunities to learn something applicable to their career by observing advanced systems of medical and health care services in Singapore. Not only that, the exchange of information among the participants enabled them to recognize remarkable differences of mortality in various countries, in particular maternal and child mortality.

It is noticeable that all of the participants' countries have achieved a significant improvement in general mortality or crude death rates. From 1950-1955 crude birth rates were 20-30 per thousand population, with the exception of very low rate of 10 in Singapore, but now has declined to less than 10, which is similar to the rates of developed countries, although the population of the elderly is much higher in developed countries.

This sharp reduction of mortality demonstrates that health and welfare conditions have been greatly improved.Much remains to be done, however, in less developed countries to reduce infectious diseases and child mortality.Infant mortality illustrates differences in social development existing not only between developed and less.

developed countries but also among less developed countries. Bangladesh and Pakistan indicate very high infant mortality levels, 91 and 85 respectively, but the level is very low in Thailand and the Philippines, 32 and 40 respectively and exceptionally low in Singapore with only 5 (see table 1). It should be noted that infant mortality rate is not affected by the age structure of population, not like crude death rate, because infant mortality rate is the number of infant deaths per 1 000 live births

Infant mortality rate is also meaningful demographically. High fertility tends to be closely connected with high infant mortality. Infant mortality rates are extremely high in Pakistan, and Bangladesh where fertility rates (TFR) are also very high (table 1). On the other hand, in Thailand and China, with low infant mortality rates, fertility rates are now below replacement level. Different development stages and policies have resulted in deviation from the norm, as shown in the case of the Philippines. Although its fertility rate is higher than that of Bangladesh, the infant mortality of the Philippines is much lower than that of Bangladesh.

Singapore's infant mortality rate stands out among other counties. According to data made available by a local statistician, it is 3.6 per 1000 live births in 1997. This is slightly lower than 3.7 of Japan in the same year, which was the lowest in the world. Now, Singapore has replaced Japan as the country with the world's lowest infant mortality rate

The lecturers gave an excellent presentation based on the experiences in Singapore. Detailed presentations provided at the K K Women's and Children's Hospital and the Woodlands Polyclinic, both unique to Singapore, offered a wonderful opportunity for the participants to learn what has been done in Singapore in order to achieve this drastic improvement of health conditions and significant reduction of mortality, particularly infant mortality.

There are several reasons why the first study course outside of Japan was so successful.

First is the selection of place of meeting where good information and secretariat assistance are available. It was very fortunate that Singapore agreed to cooperate with AUICK in organizing the meeting. Singapore is an exceedingly excellent model in terms of economic and social development with abundant successful experience in achieving a very low level of mortality and fertility. They have accumulated information and data that are extremely useful for participants coming from demographically less developed countries.

Second, the subjects of focus in this study course were very practical for the participants who are key players in their respective fields. ICPD recommended the enhancement of activities related to reproductive health care system. However, systems and programs dealing with reproductive health care needs are quite different from one country to the next and also from one city to the next. The participants must have obtained some clue as to what to apply to their own cities from Singapore model.

Third, the participants are carefully selected by each city. Most of them are medical doctors or administrators directly responsible for public health activities.

Finally, I believe that participants must have been impressed by the surprisingly rapid economic and social development of Singapore, such a tiny city-state where there are no natural resources, even water. In particular, the big difference of infant mortality rate between their countries and Singapore must have impressed them deeply. I believe the study course marked a starting point for them to consider seriously how to benefit from the example set by Singapore.

We have a tremendous role to play as a catalyst and a training ground in the field of Asian urbanization and demographic issues, which are critically reflecting basic development in Asia.